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PROMs data show no difference in TKR and UKR outcomes 6 months postoperatively
The researchers used National Joint Registry for England and Wales data and said their unicondylar knee replacement findings contradict reports from independent studies.
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An analysis of self-reported unicondylar and total knee replacement results at 6 months follow-up showed no differences between the procedures. This finding was in the context of significantly higher failure rates for unicondylar knees within worldwide registries, according to U.K. investigators.
The researchers recently conducted a large-scale review of patient-reported outcome measures (PROMs) of the two procedures recorded in the National Joint Registry for England and Wales (NJR).
Paul N. Baker, MBBS, MSc, FRCS(Eng), and colleagues studied PROMs records of nearly 24,000 patients in the NJR: 23,393 patients with a total knee replacement (TKR) and 505 patients with a unicondylar knee replacement (UKR). The study was a top paper accepted for the 13th EFORT Congress in Berlin, where Baker is scheduled to present it.
After Baker and colleagues adjusted to account for different preoperative starting points and case-mix variations, they found no significant differences in improvement between the groups. The abstract notes, this raises issues about “widespread use of an implant that does not confer a significant clinical outcome benefit.”
“Clinically, surgeons have to put this information in the context of the other information that we already have about the higher failure rates with unicondylar knee replacements. You have to make a decision about [it] if you are faced with a patient who is eligible for both a unicondylar and a total knee replacement: what is the advantage of using a unicondylar knee replacement when it has no functional benefit, yet has a failure rate that is three times higher than total knee replacement?” Baker told Orthopaedics Today Europe in an interview prior to the Congress. “We need to be more selective given the evidence.”
Baker said a possible study limitation is the NJR only contains information on procedures funded by the National Health Service in the U.K. UKRs are also performed independently or by private practitioners and those results would not be readily available for study.
PROMs, when used in conjunction with traditional methods of data analysis, will play an increasingly important role in the future of orthopaedics, Baker said. – by Jeff Craven
Reference:For more information:
- Baker PN, Petheram T, Jameson SS, et al. Comparison of patient reported outcome measures following total and unicondylar knee replacement. Scheduled to be presented May 25, 13:30-15:00, at the 13th EFORT Congress 2012. May 23-25. Berlin.
- Paul N. Baker, MBBS, MSc, FRCS(Eng), can be reached at the Department of Orthopaedics, James Cook University Hospital, Middlesbrough, TS3 4BW, United Kingdom; +44-16-4285-4479; email: drpnbaker@hotmail.com.
- Disclosure: Baker is a paid fellow for the NJR.